"Virtual visits" unpopular among cancer survivors

Last Updated: 2011-12-15 16:13:02 -0400 (Reuters Health)

By Genevra Pittman

NEW YORK (Reuters Health) - In a new survey of breast cancer survivors, few people said that having a follow-up appointment with a doctor or nurse over the phone or online instead of in person would ease their stress and worry.

Some researchers believe so-called virtual visits might be an option for continuing care as the number of cancer survivors in the United States grows and cancer doctors are stretched increasingly thin.

"There's been a lot of interest in introducing virtual visits into medical oncology follow-up," said study co-author Dr. Erica Mayer, from the Dana-Farber Cancer Institute in Boston.

"What we had in mind was a way in which patients and physicians could communicate with each other and discuss routine non-urgent follow-up care in a (way) that would be safe and acceptable."

Mayer told Reuters Health that phone or online appointments wouldn't be a replacement for physical exams or cancer screening that's done during in-person visits, but rather a way for survivors who are doing well and might live far from a clinic to have regular, convenient check-ins. It would also ease the strain on the medical system, Mayer said.

She and her colleagues sent surveys to 218 breast cancer survivors who had been seen at their center. In the surveys, they asked patients about their comfort with getting follow-up care from cancer doctors, primary care doctors and nurse practitioners, as well as over the phone or Internet with a doctor or nurse.

Survivors said that of those options, a visit to a cancer doctor would be the most likely to decrease their appointment-related stress and their worry about cancer. The most participants -- almost 80 percent -- pointed to those appointments as likely to increase their survival.

More than half of people also said that visiting a primary care doctor or nurse practitioner would decrease their disease-related worrying and would likely extend their lifespan.

But survivors were much less confident about benefiting from a virtual visit.

Only 12 percent of survey participants said communicating with a cancer doctor or nurse on the phone or online would relieve their stress about the follow-up "visit." Twenty percent said it would decrease their cancer worrying and improve their survival. More survivors said the visits would increase their stress and worrying and likely cut their lifespan.

"When patients first hear, 'Oh, we can do a follow-up from your house, you don't even have to come in,' it might seem like they're not getting as good care," said Dr. Christine Hill-Kayser, a radiation oncologist at the Hospital of the University of Pennsylvania in Philadelphia, who was not involved in the new study.

The idea of the virtual visit is still a pretty new one, Hill-Kayser said, and the phone or online sessions -- using Skype, for instance -- aren't something most survivors have access to yet.

She said that in the future, researchers and doctors will have to do a better job of educating patients about the benefits of virtual visits and being clear about what they involve. Ultimately, she added, online follow-up is a promising option to help keep survivors and their medical team better connected.

"There's some potential benefit to being able to be in touch with survivors more often and in a way that's more convenient for them," Hill-Kayser told Reuters Health.

"We're certainly working in an environment with limited resources. It's sometimes difficult to schedule follow-ups as much as we'd like to with all our patients."

Mayer said that because the survey had to be brief, the researchers weren't able to fully explain what might go into a virtual visit, and that could have colored survivors' opinions of them.

Her team wrote in the Journal of Clinical Oncology that the survey did show survivors would be comfortable having follow-up care led by their primary care doctors and by nurse practitioners -- not only cancer doctors.

That's in line with research showing that survivors do just as well in those cases, Mayer pointed out, which may help shape the future picture of cancer survivor care.

"Establishing new and efficient models of care that involve sharing care among providers or even introducing an Internet option would be favorable and helpful moving forward," she concluded.